Healthcare Provider Details

I. General information

NPI: 1952319014
Provider Name (Legal Business Name): JESSE LITTLETON ZEIGLER III PHARMACIST B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRONT ST W MARTY SHOPPING CENTER
COEBURN VA
24230-3607
US

IV. Provider business mailing address

2724 WARREN DR. P O BOX 799
SAINT PAUL VA
24283-0799
US

V. Phone/Fax

Practice location:
  • Phone: 276-395-2257
  • Fax: 276-395-3526
Mailing address:
  • Phone: 276-762-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202005543
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: